نقش نارضایتی از بدن در شروع و حفظ آسیب شناسی تغذیه ای: سنتز یافته های پژوهش

Objective: Recent findings implicate body dissatisfaction in the development and maintenance of eating pathology. This paper reviews theory and empirical findings regarding the putative origins and consequences of body dissatisfaction because recent findings have not been synthesized or critically evaluated and because these findings have key etiologic and prevention implications. Methods: A computer-assisted literature review was conducted to locate relevant prospective and experimental studies. Results: There is evidence that perceived pressure to be thin, thin-ideal internalization and elevated body mass, but not early menarche, increase the risk for subsequent body dissatisfaction. There is also consistent support for the assertion that body dissatisfaction is a risk factor for eating pathology and that this relation is mediated by increases in dieting and negative affect. Conclusions: This review provides support for the claim that sociocultural processes foster body dissatisfaction, which in turn increase the risk for bulimic pathology, and suggests that prevention and treatment interventions might be enhanced by focusing greater attention on body image disturbances.

Eating disorders are one of the most common psychiatric problems faced by females and are characterized by chronicity and high rates of relapse [1], [2] and [3]. Anorexia nervosa is characterized by emaciation, fear of becoming fat, disturbed perception of body shape, undue influence of shape on self-evaluation, denial of the seriousness of low body weight and amenorrhea (for females). Bulimia nervosa is marked by uncontrollable binge eating, compensatory behavior to prevent weight gain (e.g., vomiting) and undue influence of shape on self-evaluation. Eating disorders are marked by medical complications, psychosocial impairment and comorbid psychopathology, and have the highest levels of treatment seeking, inpatient hospitalization, suicide attempts and mortality of common psychiatric syndromes [4] and [5]. Furthermore, eating pathology increases the risk for onset of obesity, depression and substance abuse [6], [7] and [8]. Accordingly, it is important to elucidate the processes that result in the onset and maintenance of eating pathology so that optimally effective preventive and treatment interventions can be developed.

In closing, this review found that there was prospective and experimental support for the assertion that perceived pressure to be thin, thin-ideal internalization and elevated body mass increase the risk for subsequent body dissatisfaction. However, there was no support for the hypothesis that early menarche is a risk factor for body dissatisfaction. There was also prospective and experimental support for the suggestion that body dissatisfaction increases the risk for subsequent eating pathology and that this relation is mediated by increases in dieting and negative affect. These findings are consonant with the general notion that sociocultural processes foster body dissatisfaction, which in turn increases the risk for eating pathology. These results suggest that prevention and treatment interventions might be enhanced by focusing greater attention on body dissatisfaction, although other aspects of program delivery appear to be quite important (e.g., use of universal versus selected interventions). Additional prospective and experimental studies are needed to more firmly establish the nature of these relations and to elucidate the factors that amplify and mitigate the precursors and consequences of body image disturbances. Thus, although impressive advances have been made regarding the precursors and consequences of body dissatisfaction, many questions remain unanswered regarding this pervasive problem.